In response to PA-04-061 (Research on Rural Mental Health and Drug Abuse Disorders), we propose to examine mental health service use and outcomes of Medicaid-enrolled children and adolescents with emotional and behavioral problems living in rural areas in Tennessee and Mississippi. This project has two primary aims. The first is to generate new knowledge on rural children's use of mental health services by: a) describing differences in predisposing, enabling, and need characteristics between rural and non-rural Medicaid-enrolled children; b) testing hypotheses about differences between rural and non-rural populations in access, service use patterns, and clinical outcomes. The second aim is to refine operational definitions of "rural residence" and theoretical models of service use and outcomes for future rural health services research. The project will use previously collected interview and administrative (i.e., eligibility and encounters/claims) Medicaid data. Such secondary analysis is an efficient method for examining the experiences of children and adolescents struggling with behavioral health problems in rural settings. Descriptive and hypothesis-testing analyses will address the following questions: 1.) What are the child, family, and community-level characteristics of Medicaid-enrolled rural children with special attention to emotional and behavioral disorders? 2.) What types of mental health services do Medicaid-enrolled rural children use, and what are their patterns of service use (including access)? 3.) What clinical outcomes of treatment do rural children experience? 4) What factors predict service use and clinical outcomes among rural children? For each question, we will also answer: How do these differ from non-rural children? Analyses to test service use and outcome differences will incorporate child, family, community, and service system factors as described in the theoretical model.